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sming

Incredibly intense anxiety, irritability and anger on Wellbutrin

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Respectful greetings, fellow crazies.

I've recently ramped-up on Wellbutrin: 150mg for 6 days and then 300mg for 12 days (18 days total). Overall it's slightly helping the multitude of mental illnesses I have (TRD, "Pure" OCD, other stuff).

However. About 7 days after hitting 300mg Wellbutrin I started experiencing incredibly intense anxiety primarily (physically shaking, gut-churning, mind-racing, skin-crawling kind). I also started feeling erratic, intense irritability and even anger - (verbally) lashing out at my kids and other unpleasant out-of-character behaviour.

I've seen anxiety from Wellbutrin reported 100's of times before but I couldn't find information on how to combat it. This is because normally people just stop taking it (which makes eminent sense) but that's not an option for me since I'm 23 years TRD (including resistance to ECT, dTMS and Ketamine) and this is one of the last combos left. In other words I'm beyond desperate to give it every chance of working that I humanly can.

I'm now gonna blurt out my questions and suggestions and hope that some of you can identify or comment from your own experience:

  • I have some Valium left over and taking that does take the edge off of the severe emotions. However taking benzo's long-term is generally undesirable, hence has anyone taken a non-benzo adjunct/augmenting med that actually helps tone down the insane anxiety? If so, what was it?
  • how long did the intense anxiety last for those who experienced it? 2 weeks? a month? until you stopped the med?
  • did anyone have success in simply reducing dose back to 150mg or even lower? Did you find 150mg sufficient to lift your mood?
  • I'm on 300mg XL as of today (was on 2x150mg XL 'til now). Have folks had different experiences (anxiety-wise) with the IR or SR versions? E.g. would switching to 3xIR be an avenue worth chasing?
  • any other relevant insights or experiences would also be most welcome.

May the Gods of mental health be with you,

Pete

 

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55 minutes ago, sming said:

Respectful greetings, fellow crazies.

I've recently ramped-up on Wellbutrin: 150mg for 6 days and then 300mg for 12 days (18 days total). Overall it's slightly helping the multitude of mental illnesses I have (TRD, "Pure" OCD, other stuff).

However. About 7 days after hitting 300mg Wellbutrin I started experiencing incredibly intense anxiety primarily (physically shaking, gut-churning, mind-racing, skin-crawling kind). I also started feeling erratic, intense irritability and even anger - (verbally) lashing out at my kids and other unpleasant out-of-character behaviour.

I've seen anxiety from Wellbutrin reported 100's of times before but I couldn't find information on how to combat it. This is because normally people just stop taking it (which makes eminent sense) but that's not an option for me since I'm 23 years TRD (including resistance to ECT, dTMS and Ketamine) and this is one of the last combos left. In other words I'm beyond desperate to give it every chance of working that I humanly can.

I'm now gonna blurt out my questions and suggestions and hope that some of you can identify or comment from your own experience:

  • I have some Valium left over and taking that does take the edge off of the severe emotions. However taking benzo's long-term is generally undesirable, hence has anyone taken a non-benzo adjunct/augmenting med that actually helps tone down the insane anxiety? If so, what was it?
  • how long did the intense anxiety last for those who experienced it? 2 weeks? a month? until you stopped the med?
  • did anyone have success in simply reducing dose back to 150mg or even lower? Did you find 150mg sufficient to lift your mood?
  • I'm on 300mg XL as of today (was on 2x150mg XL 'til now). Have folks had different experiences (anxiety-wise) with the IR or SR versions? E.g. would switching to 3xIR be an avenue worth chasing?
  • any other relevant insights or experiences would also be most welcome.

May the Gods of mental health be with you,

Pete

 

From a maintenance perspective, i can get by with 150xl. Note that I'm not on monotherapy however.

However, if i hit a stretch were it seems to be going downhill and lasts for a few days, a few weeks of 300 xl or 2x 100 IR does the trick for me.

It does however, feel quite a bit different between 150xl and 300xl or 2x 100 IR. I find 150xl to be very subtle.

IR actually felt a bit better than 300xl, however it sort of made me sleepy about an hr after I took it.

None of the  doses made me irritable or anxious (it actually calmed me down mentally, despite the insomnia), however, it was most for the reason of insomnia (early awakening) that I had to cut the dose. I suppose there might have been a downstream effect, as bad sleep = feel fine/clear for a few days (don't really need as much sleep though I'd like to sleep), then irritable, then angry and/or depressed.

 

 

 

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3 hours ago, argh said:

From a maintenance perspective, i can get by with 150xl. Note that I'm not on monotherapy however.

Thank you for your reply. That's good to know. FTR I'm also on 0.5mg Mirapex, 60mg Adderall and 15mg Percocet for chronic pain.

I'm just in such a negative emotional & mental state right now, that I need some "real world" data to give me the strength to see it through for 4-6 weeks.

Pete

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1 hour ago, sming said:

Thank you for your reply. That's good to know. FTR I'm also on 0.5mg Mirapex, 60mg Adderall and 15mg Percocet for chronic pain.

I'm just in such a negative emotional & mental state right now, that I need some "real world" data to give me the strength to see it through for 4-6 weeks.

Pete

FWIW, a ton of the initial side effects and extra stimulation fades after the initial few weeks. There were two recent members which had issues with the initial agitation but ended up working through it. 

I believe it was @icygrave and @Sync .

I'd recommend you check their threads about it for more real world support. Last time i read those threads, they were doing well.

Wellbutrin, despite not being an SSRI, is know to take a while to really kick in. Like 6+ weeks or so. I didn't notice a major difference in my MDD until about week 8 or 9. Yeah it helped a bit in the prior weeks, but didn't really kick till then.

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Yeah, I had insane anxiety, agitation, restlessness, etc when I first started Wellbutrin. No anxiety at 100mg IR, wildly out of control anxiety on 200mg IR, and somewhat less out of control anxiety on 150mg XL. Anxiety on 150mg for me persisted for a few weeks and then went away. As of now my anxiety is better than ever, although I do have some weird mild hypervigilance sx I didn't before. On the whole it's a fantastic med for me, though. Like a bulldozer for my depression.

I'm great on 150mg, but like Argh I'm not taking it by itself. IIRC sertraline and bupropion increase each other's blood levels, so take that as you will. 

Quote

erratic, intense irritability and even anger 

Yeah, had that too. I was real impulsive and angry at everything for a while there. Definitely overly "up." That also settled down, although I definitely remain more assertive and prone to action than I used to be, which is actually fantastic, frankly. 10/10 would suffer through those nasty couple of weeks again.

If the 300 is really too overwhelming, you could always try the 150 for a bit to see if it works. IIRC 300 is the most common dose for monotherapy, but everyone's biology is different, so who knows. 

As far as IR vs XL, IR was definitely more... unstable, I wanna say. I'd be UP and then crash super hard, and was much more jittery in general. I wouldn't expect it'd be better for anxiety, but I personally didn't notice much of a difference there either way. I much prefer the XL in general though.

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19 hours ago, Sync said:

Yeah, I had insane anxiety, agitation, restlessness, etc when I first started Wellbutrin. No anxiety at 100mg IR, wildly out of control anxiety on 200mg IR, and somewhat less out of control anxiety on 150mg XL. Anxiety on 150mg for me persisted for a few weeks and then went away. As of now my anxiety is better than ever, although I do have some weird mild hypervigilance sx I didn't before. On the whole it's a fantastic med for me, though. Like a bulldozer for my depression.

I'm great on 150mg, but like Argh I'm not taking it by itself. IIRC sertraline and bupropion increase each other's blood levels, so take that as you will. 

Yeah, had that too. I was real impulsive and angry at everything for a while there. Definitely overly "up." That also settled down, although I definitely remain more assertive and prone to action than I used to be, which is actually fantastic, frankly. 10/10 would suffer through those nasty couple of weeks again.

If the 300 is really too overwhelming, you could always try the 150 for a bit to see if it works. IIRC 300 is the most common dose for monotherapy, but everyone's biology is different, so who knows. 

As far as IR vs XL, IR was definitely more... unstable, I wanna say. I'd be UP and then crash super hard, and was much more jittery in general. I wouldn't expect it'd be better for anxiety, but I personally didn't notice much of a difference there either way. I much prefer the XL in general though.

It's pretty alarming, isn't it, when you find yourself on the brink of losing it over something trivial. 

150mg sounds like a solid option if it doesn't abate soon. I'm worried I'm going to be in the office and either cry or chew someone out viciously. And then 30 mins later be calm as you like, probably.  Thanks for the post.

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3 hours ago, sming said:

It's pretty alarming, isn't it, when you find yourself on the brink of losing it over something trivial. 

150mg sounds like a solid option if it doesn't abate soon. I'm worried I'm going to be in the office and either cry or chew someone out viciously. And then 30 mins later be calm as you like, probably.  Thanks for the post.

lmao, yep! that sounds really familiar. wildly all over the place, mood swings up the wazoo. tbh if I'd been anything less than extremely invested in making this medication work I probably would have gone off them during that time. Incredibly glad I stuck with it, fwiw.

Do you have a pdoc you can mention this stuff to? I know lots of them are hard as hell to get ahold of for things like this. 

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So interestingly my pdoc (who prides himself on being up on the literature) referenced a study that, contrary to popular belief, Wellbutrin has the potential to help anxiety and the other nasties in the long run....the problem is that doesn't make the side effects at startup any easier to overcome. Now I don't think I know anyone who actually fits that hypothesis but maybe it's worth mentioning. That said, I didn't even make it to 300 because of some of those issues...we concluded that it doesn't play nice with my bipolar 

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59 minutes ago, Iceberg said:

So interestingly my pdoc (who prides himself on being up on the literature) referenced a study that, contrary to popular belief, Wellbutrin has the potential to help anxiety and the other nasties in the long run....the problem is that doesn't make the side effects at startup any easier to overcome. Now I don't think I know anyone who actually fits that hypothesis but maybe it's worth mentioning. That said, I didn't even make it to 300 because of some of those issues...we concluded that it doesn't play nice with my bipolar 

Wellbutrin actually helped my anxiety. I went all the way up to 500 mg and didn't fell agitated or anything, I actually felt pretty chill. The constipation and seizures were what made me have to stop it.

10 hours ago, sming said:

It's pretty alarming, isn't it, when you find yourself on the brink of losing it over something trivial. 

150mg sounds like a solid option if it doesn't abate soon. I'm worried I'm going to be in the office and either cry or chew someone out viciously. And then 30 mins later be calm as you like, probably.  Thanks for the post.

They make 75 mg and 100 mg instant-release tablets that you can split. You can get really creative with this dose. Things like:

  • 75 mg + 37.5 mg = 112.5 mg
  • 75 mg + 18.75 mg = 93.75 mg
  • 37.5 mg + 37.5 mg = 75 mg
  • 37.5 mg + 18.75 = 55.75 mg
  • 18.75 mg + 18.75 = 37.5 mg

They also make a Wellbutrin SR version, which is intended to be taken twice daily, but it could work once daily for some people. It comes in 100 mg, 150 mg, and 200 mg tablets.

Edited by mikl_pls

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10 hours ago, Sync said:

lmao, yep! that sounds really familiar. wildly all over the place, mood swings up the wazoo. tbh if I'd been anything less than extremely invested in making this medication work I probably would have gone off them during that time. Incredibly glad I stuck with it, fwiw.

Do you have a pdoc you can mention this stuff to? I know lots of them are hard as hell to get ahold of for things like this. 

Well my digits are crossed that this is a phase that ends soon.

Yes. I intend to ask for a benzo since they're effective for me but he's going to say "no" because a) benzo's are evil incarnate according to almost all inexperienced doctors, b) I'm already on Percocet which is also a CNS suppressant. God knows what he's going to put me on :/

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3 hours ago, mikl_pls said:

Wellbutrin actually helped my anxiety. I went all the way up to 500 mg and didn't fell agitated or anything, I actually felt pretty chill. The constipation and seizures were what made me have to stop it.

That's amazing, isn't it. Just goes to show our idiosyncrasies when it comes to psychotropics. I have IBS-C and take Percocet so the constipation I'm getting is par for the course, lamentably :/

Quote

They make 75 mg and 100 mg instant-release tablets that you can split. You can get really creative with this dose. Things like:

  • 75 mg + 37.5 mg = 112.5 mg
  • 75 mg + 18.75 mg = 93.75 mg
  • 37.5 mg + 37.5 mg = 75 mg
  • 37.5 mg + 18.75 = 55.75 mg
  • 18.75 mg + 18.75 = 37.5 mg

They also make a Wellbutrin SR version, which is intended to be taken twice daily, but it could work once daily for some people. It comes in 100 mg, 150 mg, and 200 mg tablets.

I've thought about this. I was initially prescribed 150mg XR twice per day so I tried taking one at 7am and one at 1pm but it did not seem to alleviate the intensity of the anxiety unfortunately. I'm so desperate to give WB a "good crack of the whip" though, I'm determined to make it to at least 4 weeks. Good job I have some leftover Valium or I'd have been arrested or something by now, lol.

Actually @mikl_pls, do you know of any common non-benzo adjuncts for WB that help with the anxiety? For example I think I rather liked Buspirone when I tried it alongside Lexapro. I'd like to go in armed with some research and questions. 

Edited by sming
additional question

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2 minutes ago, sming said:

Well my digits are crossed that this is a phase that ends soon.

Yes. I intend to ask for a benzo since they're effective for me but he's going to say "no" because a) benzo's are evil incarnate according to almost all inexperienced doctors, b) I'm already on Percocet which is also a CNS suppressant. God knows what he's going to put me on :/

How about buspar? Has a bit of a start up lead time though. 

Vistaril?

Neurontin or lyrica?

Iirc, lyrica is schedule 5 or whatever is the least restrictive controlled substance, but the rest as fairly innocuous. Neurontin might raise an eyebrow if you are in opiate country.

 

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6 minutes ago, argh said:

How about buspar? Has a bit of a start up lead time though. 

Vistaril?

Neurontin or lyrica?

Iirc, lyrica is schedule 5 or whatever is the least restrictive controlled substance, but the rest as fairly innocuous. Neurontin might raise an eyebrow if you are in opiate country.

 

Lol I just mentioned Buspirone. Don't know Vistaril, will check it out - thanks mate.

Morontin and Lyrica I do know. After being on both for considerable amounts of time at considerable doses I still couldn't honestly tell you what they did for me - if anything. They do work wonders for some folks though, that's for sure. Humans eh? Such a weird bunch.

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54 minutes ago, sming said:

Actually @mikl_pls, do you know of any common non-benzo adjuncts for WB that help with the anxiety? For example I think I rather liked Buspirone when I tried it alongside Lexapro. I'd like to go in armed with some research and questions. 

BuSpar actually isn't a benzo, but works similarly to an SSRI in that it downregulates presynaptic 5-HT1A and stimulates postsynaptic 5-HT1A receptors which disinhibits serotonin release and causes downstream dopamine release, respectively. It also, in low doses, antagonizes D2 presynaptic autoreceptors so as to disinhibit dopamine release. Higher doses will antagonize the postsynaptic receptors, which will have a slight antipsychotic effect "dopamine blockade). I mean, It may be worth a try. But BuSpar works best alongside SSRIs so I've heard. Personally, BuSpar made me ultra-manic, but I'm bipolar. Also, it says in your signature that you're taking Nardil, which I don't know if that's up to date, but taking Nardil with BuSpar is absolutely contraindicated.

Vistaril can simply just make you drowsy. I've never really had any benefit with it eliminating my anxiety. Neurontin never did much for my anxiety except make me loopy-headed. Never tried Lyrica. The old-school antipsychotic Stelazine did wonders for my anxiety, but I doubt your pdoc would prescribe it.

One thing to consider might be to go to a SSRI/SNRI + a stimulant (Ritalin/Adderall) as an adjuvant agent.

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1 hour ago, sming said:

Lol I just mentioned Buspirone. Don't know Vistaril, will check it out - thanks mate.

Morontin and Lyrica I do know. After being on both for considerable amounts of time at considerable doses I still couldn't honestly tell you what they did for me - if anything. They do work wonders for some folks though, that's for sure. Humans eh? Such a weird bunch.

Vistaril is a first gen anti-histamine which is used on label for anxiety. It has h1 inverse agonism and some 5-HT2A antagonism, which supposedly is what makes it calming. At possibly heroic doses, it can antagonize D2 somewhat.

Yeah, no kidding. Humanity is a weird bunch, especially when it comes to the crazies. Funny how for every drug or combo that is a lifesaver to some, it's completely useless or detrimental to others.

Full disclosure of course, Vistaril was/is pretty awful for me. Ironically caused the irritability issues you describe in the OP,  for me. I take it occasionally when I need to knock myself out, but I've got trazodone right now to deal with that. What helped me significantly, for depression and possibly anxiety, more than wellbutrin is neurontin. ha. Humans, eh?

 

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On 12/2/2018 at 9:15 PM, argh said:

Wellbutrin, despite not being an SSRI, is know to take a while to really kick in. Like 6+ weeks or so. I didn't notice a major difference in my MDD until about week 8 or 9. Yeah it helped a bit in the prior weeks, but didn't really kick till then.

The standard dose of Wellbutrin is 300 mg but most start at 75 or 150 mg to hopefully avoid side effects that work themselves out over time. This is what takes so long, titrating up. I did not find Wellbutrin particularly stimulating, at best weakly so, but I have taken a number of noradrenaline affecting drugs and they don't seem to bother me too much. 

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On 04/12/2018 at 11:46 AM, sming said:

Well my digits are crossed that this is a phase that ends soon.

Yes. I intend to ask for a benzo since they're effective for me but he's going to say "no" because a) benzo's are evil incarnate according to almost all inexperienced doctors, b) I'm already on Percocet which is also a CNS suppressant. God knows what he's going to put me on :/

Quoting myself here which is a bit weird but it's pertinent. 

Saw PDoc an hour ago. Told him I was super-depressed, neurotic, had skin-crawling anxiety, was literally on the verge of tears 24/7. And... he said to stick to 300mg Wellbutrin.

TBF the data is on his side (you have to give shit 4+ weeks minimum), and people on this thread have backed that up. But the state I'm in, it was not what I wanted to hear. Plus the fact that I feel hugely overmedicated.

I was wrong about the benzo though and he prescribed 0.5 Ativan (he feels 0.5 Ativan+15 Percocet is super low risk) which should help with the crawling-up-the-walls anxiety at least, if not the bleak depression.

Right then. 13 more days at 300mg Wellbutrin to go after either: 
A) I waltz into his office and give him a big smacker on the cheek for making me stick it out and making my life bearable (and possibly saving my marriage)
B) I stumble into his office, barely suppressing the raging urge to wring his pig-headed neck 

BTW I've updated my signature multiple times but it's still showing a really old one. Anyone know what's up with that?

Edited by sming
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So today marks 2.5 weeks on Wellbutrin 300mg and 4+ weeks on Mirapex 0.5mg. 

I just had the most intense, lengthy period of "real" suicidal ideation I've had in many, many months. I was thinking of locations, implications, effects on friends and family and so on. I had intense back pain at the time but "it's been coming": all week I've been weepy, very depressed and morose, interspersed with extended periods of incredibly strong anxiety - like gut-wrenching, skin-crawling anxiety. 

My PDoc, who's quite a cnut frankly, said not to contact him for 2 weeks unless it's a real emergency so I can't ping him to suggest perhaps dropping to 150mg Wellbutrin or something. And there's that part of me that desperately wants to stick it out at 300mg for 4+ weeks, just in case I can "break through" and get the full AD effect of 300mg Wellbutrin.

I just don't know what to do. I have virtually no other meds options left to try and this current regimen is making me feel inhumanly bad. I know that meds often make you feel worse before making you feel better, but this seems outside of that envelope. It feels disturbingly dangerous.

Pete

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23 minutes ago, sming said:

I just had the most intense, lengthy period of "real" suicidal ideation I've had in many, many months. I was thinking of locations, implications, effects on friends and family and so on. I had intense back pain at the time but "it's been coming": all week I've been weepy, very depressed and morose, interspersed with extended periods of incredibly strong anxiety - like gut-wrenching, skin-crawling anxiety.

24 minutes ago, sming said:

My PDoc, who's quite a cnut frankly, said not to contact him for 2 weeks unless it's a real emergency

This to me sounds like it's a "real emergency" to contact your cunt of a pdoc. Seriously though? Your pdoc really told you not to contact you "unless it's a 'real' emergency?" That's asinine... 

If your pdoc is unwilling to talk with you, I would seriously consider going to the ER if you feel you are a danger to yourself.

27 minutes ago, sming said:

I just don't know what to do. I have virtually no other meds options left to try and this current regimen is making me feel inhumanly bad. I know that meds often make you feel worse before making you feel better, but this seems outside of that envelope. It feels disturbingly dangerous.

Have you ever tried combining an MAOI + TCA or MAOI + stimulant or even MAOI + TCA + stimulant? Supposedly these combos are supposed to work for people who have even failed ECT. I have tried MAOI + stimulant and MAOI + TCA + stimulant and it brought me a little to far above euthymia... lol... especially the latter combination. Parnate + Adderall was the best combo ever, if I go into as dark and deep of a pit as I was in again, that's the combo I'm going to beg my pdoc to put me back on again, weight gain be damned.

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